An elderly gentleman with a hx of BPH who presented to ED with an elevated creatinine, abdominal distention, and new-onset nocturia and dribbling with urination. 2 L of urine came out with straight cath. His course was complicated by hematuria and a drop in hemoglobin secondary to rapid bladder decompression. He required foley catheter placement and eventually placement of a three way foley. Obstruction was ultimately deemed to be due to his longstanding BPH and he underwent TURP with relief of his symptoms.
Pearls:
-Hematuria can be a complication of rapid bladder decompression. This patient’s Hb dropped from 11 -> 8!
-Post-obstructive diuresis is a very significant complication and these patients need to be monitored for electrolyte imbalances, severe dehydration, and hypovolemic shock
-Make sure you keep these patient’s hydrated with fluids while they are undergoing post-obstructive diuresis!!
-When a foley catheter becomes clotted, placement of a 3-way Foley is placed which allows for continuous bladder irrigation
Kaiser SF Internal Medicine Residency Blog 